Epidemiology of complex bone and joint infections in France using a national registry: The CRIOAc network
In France, a network of reference centers for bone and joint infections (BJI) was created
in 2008, focused on the management of complex BJI (previous failure, difficult-to-treat microorganisms,
heavy comorbidities or surgical procedures). A national registry was implemented from 2012, collecting
decisions advised in periodic multidisciplinary meetings. We present here an epidemiological overview.
Methods: All consecutive adult patients presented from 2014 to 2019 in 23/30 reference centers were
included in this cohort. Characteristics of patients, BJI, and medico-surgical management advice were
27,483 individual patients were included, corresponding to 28,365 distinct infectious episodes,
which 17,328 were complex. Median age was 65 years, with 62% of men, 1/3 patients presented more
than 2 comorbidities. Prosthetic joint infections (PJI) represented 42% of all BJIs (11,812 episodes). Staphylococcus aureus, coagulase-negative staphylococci and polymicrobial PJI represented 26%, 25% and 16% respectively. DAIR (debridement, antibiotics and implant retention) was proposed for 3,157 (27%), whereas
one-stage and two-stage revision for 3,683 (31%) and 1,764 (15%). An antibiotic treatment was advised in
10,493 episodes (87%), with combination therapy in 88%.
This national network allows an optimized management of complex BJIs. Its cohort is a
unique opportunity to draw up a detailed epidemiological picture and to follow the trends of these infrequent infections